Correlation of Pre-Operative Co-Morbidity Indices with Peri-Operative and Post-Operative Metrics in Urological Patients Undergoing Major Open Procedures

Background:Individual surgeon and institutional performance are usually assessed by morbidity and mortality rates, which can be calculated using peri-operative metrics, such as POSSUM (Physiological and Operative Severity Score for the enUmeration of mortality and morbidity). Post-operative risk can be estimated using the surgical Apgar outcome score. However, pre-operative co-morbidity may contribute to case risk diversity and affect immediate peri-operative metrics and short- and long-term morbidity and mortality. We estimated the correlation between pre-operative co-morbidity or risk assessment indices and peri-operative metrics in urological patients. Material and Methods:The study included 100 consecutive patients (80.8% males, mean age ± SD 66.3 ± 10.7 years, range 30 - 88 years) undergoing major open urological procedures (39 nephrectomies, 43 radical prostatectomies, 18 radical cystectomies). Pre-operative co-morbidity was assessed using Charlson Comorbidity Index (CCI), age-adjusted CCI (AA-CCI), Cumulative Illness Rating Scale (CIRS), and Index of Co-Existent Diseases (ICED). Pre-operative risk was assessed with the American Society of Anesthesiologists index (ASA). Functional status was quantified based on estimation of the metabolic equivalent (MET). Peri-operative metrics included POSSUM and surgical Apgar scores. Results: All pre-operative indices significantly correlated with POSSUM, but none correlated with the surgical Apgar score. Conclusions:In patients undergoing major open urological procedures, risk stratification in the post-operative setting using the surgical Apgar score is independent of pre-operative co-morbidity status. In contrast, pre-operative co-morbidity and risk assessment correlated with peri-operative metrics used to calculate morbidity and mortality risk. Reports of death and complication rates do not take into account case diversity and, therefore, should be adjusted for co-morbidity status.

Ultrasonography as the First Method of Choice in the Diagnosis of Primary Extrahepatic Echinococcosis: Case Report

The aim of this presentation is to show the high informative value of ultrasonography as the first method of choice in the diagnosis of atypical extra-hepatic forms of echoconcosis. Echinococcosis is zooanthroponosis and is most commonly caused by the larval form of E. granulosus. Echinococcal cysts develop, most commonly in the human liver and second - in the lung. Rare primary localization is echinococcus cysts of greater omentum and spleen. Ultrasonography is first method of ch?ice for diagnostic. The main clinical and laboratory diagnostic methods are immunoelectrophoresis and serological evidence of echinococcosis by ELISA. Timely surgical treatment give it a chance to cure. The use of post-operative antiparasitic chemoprophylaxis and therapy is recommended.